Provider Demographics
NPI:1841529096
Name:COVINGTON ASSOCIATES IN FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:COVINGTON ASSOCIATES IN FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-787-5600
Mailing Address - Street 1:PO BOX 2069
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30015-2069
Mailing Address - Country:US
Mailing Address - Phone:770-787-5600
Mailing Address - Fax:770-787-5601
Practice Address - Street 1:5294 ADAMS ST NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2628
Practice Address - Country:US
Practice Address - Phone:770-787-5600
Practice Address - Fax:770-787-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025674261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000269442MMedicaid
GA000269442MMedicaid
GAD42147Medicare UPIN